Clinical and histologic observations of monoarthritis. Anticipation of its progression to rheumatoid arthritis.
Synovial biopsies were performed on 84 patients with monoarticular synovitis from 1960 to 1984. Twenty-seven (32%) of 84 patients were pathologically differentiated; however, the other patients remained classified as nonspecific monoarthritic. Follow-up studies of nonspecific monoarthritis ranging from five to 25 years (average, 15 years) were carried out in 34 patients. Five patients (15%) disclosed polyarticular involvement and were diagnosed as having classic rheumatoid arthritis (RA) within five years after initial biopsy (RA group). In the remainder (non-RA group), 19 patients recovered completely and nine of ten patients complained of a slight degree of joint involvement. A good prognosis was observed in younger patients and in those who showed minimal histologic changes in the synovium. Initial laboratory examinations, including a white cell count, erythrocyte sedimentation rate, C-reactive protein, and agglutination test, did not show any differences between the RA and the non-RA groups. To determine predicting factors for RA, a comparative histologic study of the initial specimens was performed. Specimens from the RA group showed a predominant appearance of lymphoid aggregates, high endothelial postcapillary venules, and proliferative plasma cell infiltration. These histologic features suggest the future appearance of RA; therefore, careful observation and early treatment should be considered for these patients.
Iguchi
T
T
Department of Orthopaedic Surgery, School of Medicine, Kobe University, Japan.
Matsubara
T
T
Kawai
K
K
Hirohata
K
K
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D001168:Arthritis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D001172:Arthritis, Rheumatoid / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D002449:Cell Aggregation; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia; D007223:Infant; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013585:Synovitis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D014699:Venules / Q000473:pathology